Facial Nerve Palsey

Question 1

What is it

Answer 1

Dysfunction of the facial nerve (cranial nerve VII), leading to weakness or paralysis of the muscles of facial expression.

Question 2

Clinical Features

Answer 2

Unilateral facial weakness (unable to raise eyebrow, close eye, or smile) 😊❌
Loss of forehead wrinkling (in LMN lesions)
Drooping of the mouth on the affected side 😕
Difficulty closing the eye (lagophthalmos), leading to dry eye 👁️
Loss of taste on the anterior 2/3 of the tongue 👅
Hyperacusis (increased sensitivity to sound) if nerve to stapedius is affected 🎵🔊

Question 3

Epidemiology

Answer 3

• Most common cause of acute facial paralysis
• Bell’s palsy accounts for ~60-70% of cases
• Can be idiopathic or secondary to infections, trauma, stroke, or tumors

Question 4

Age Groups Affected

Answer 4

All ages can be affected
Bell’s palsy most common in 15-45 years
Stroke-related facial palsy more common in older adults

Question 5

Risk Factors

Answer 5

✅ Modifiable:
Viral infections (HSV, VZV, Lyme disease, HIV, COVID-19) 🦠
Diabetes mellitus 🍬
Hypertension
Pregnancy (especially 3rd trimester or postpartum) 🤰
Smoking 🚬

🚫 Non-Modifiable:
Genetic predisposition
Autoimmune conditions (Guillain-Barré syndrome, MS)
Trauma (e.g., temporal bone fractures)

Question 6

Clinical Presentation

Answer 6

🔹 Bell’s Palsy (Idiopathic, LMN Lesion – Most Common)
Sudden onset unilateral facial weakness (within 72 hours)
Inability to raise eyebrow or close eye
Loss of taste (anterior 2/3 of tongue)
Hyperacusis (increased sound sensitivity)
No other neurological signs

🔹 Stroke-Related Facial Palsy (UMN Lesion – Emergency 🚨)
Facial weakness sparing the forehead (forehead still moves)
Other neurological deficits (e.g., limb weakness, speech difficulty)

🔹 Ramsay Hunt Syndrome (VZV Reactivation)
Facial weakness + painful vesicles in the ear 🎵
Severe pain, hearing loss, dizziness (vestibular involvement)

Question 7

Prognosis

Answer 7

🔹 Bell’s Palsy (Most Cases):
80-90% recover within 3 months
Steroids + antivirals (if HSV suspected) can improve recovery

🔹 Stroke-Related:
Requires urgent stroke treatment (thrombolysis if within the window period)
Recovery depends on extent of brain damage

🔹 Ramsay Hunt Syndrome:
Slower recovery than Bell’s palsy, often incomplete recovery

🔹 Prevention:
Manage risk factors (diabetes, hypertension, infections)
Eye protection in severe cases to prevent corneal damage

Question 8

Test

Answer 8

Ask bout dry mouth

Facial expression test - surprised, shocked, angry

In OSPE - if not satisfied id move on to -
Try and move eyebrows, push air our of cheeks